Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosis
Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosis
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DOI：
10.1016/j.athoracsur.2004.09.002
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发表时间：
2005-04-01
影响因子：
4.6
通讯作者：
Quaini, E
中科院分区：
文献类型：
--
作者：
Tasca, G;Brunelli, F;Quaini, E
背景既往研究报告称，患者-人工瓣膜不匹配可能与左心室肥厚消退较少相关。然而，在不匹配的患者中，左心室质量消退的程度在不同患者之间有显著差异，我们假设这可能与主动脉瓣置换术后瓣膜面积增加的幅度有关。我们的目的是研究主动脉瓣置换术后瓣膜有效瓣口面积的改善与患者-假体不匹配患者术后左心室质量消退程度之间的关系。通过多普勒超声心动图测量111例单纯性主动脉瓣狭窄患者术前和术后的瓣膜有效瓣口面积、跨瓣压差和左心室质量，这些患者在术后有效瓣口面积指数≤ 0.8 cm 2/m2时被发现存在患者-人工瓣膜不匹配。平均而言，手术后瓣膜有效瓣口面积增加0.45 +/- 0.24 cm（2）/m（2），平均跨瓣压差降低-31.6 +/- 13.5 mm Hg。术前和术后左心室质量之间的绝对和相对差异分别为-28 +/- 30 g和-17% +/-18%。多变量分析显示，术前左心室质量（p < 0.0001）和手术后瓣膜有效瓣口面积指数增加（p = 0.019）与左心室质量回归显著独立相关。本研究表明，在患者-人工瓣膜不匹配的患者中，左心室质量回归的程度受到主动脉瓣置换术实现的瓣膜有效瓣口面积增加的影响。(c)2005年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. Previous studies have reported that patient-prosthesis mismatch may be associated with lesser regression of left ventricular hypertrophy. However, among the patients with mismatch, the extent of left ventricular mass regression varied markedly from one patient to another, and we hypothesized that it could be related to the magnitude of the increase in valve area achieved with aortic valve replacement. Our aim was to examine the relationship between the improvement in valve effective orifice area obtained with aortic valve replacement and the extent of postoperative left ventricular mass regression in patients with patient-prosthesis mismatch.Methods. Preoperative and postoperative measurements of valve effective orifice area, transvalvular pressure gradient, and left ventricular mass were obtained by Doppler echocardiography in 111 patients with pure aortic stenosis who were found to have patient-prosthesis mismatch based on an indexed effective orifice area of 0.8 cm(2)/m(2) or less after operation.Results. On average, the valve effective orifice area increased by 0.45 +/- 0.24 cm(2)/m(2) with operation, and mean transvalvular pressure gradients decreased by -31.6 +/- 13.5 mm Hg. The absolute and relative differences between preoperative and postoperative left ventricular mass were -28 +/- 30 g and -17% +/- 18%, respectively. In multivariate analysis, higher preoperative left ventricular mass (p < 0.0001) and larger increase in indexed valve effective orifice area with operation (p = 0.019) were independently associated with greater left ventricular mass regression.Conclusions. This study shows that in patients with patient-prosthesis mismatch, the degree of left ventricular mass regression is influenced by the increase in valve effective orifice area achieved by aortic valve replacement. (c) 2005 by The Society of Thoracic Surgeons.